Cyclosporine: Adverse Effects and Precautions in Immunosuppression, Nephrotoxicity, and Hypertension in Transplantation

Cyclosporine is a widely used immunosuppressant in the field of solid organ transplantation to prevent graft rejection. Its efficacy in immunosuppression has been well documented, but its use is not without significant adverse effects that require careful monitoring and management.

Adverse Effects of Cyclosporine

One of the most concerning adverse effects of cyclosporine is nephrotoxicity. This drug can induce histological changes such as obliterative vasculopathy of the afferent arteriole and tubulointerstitial fibrosis, which can lead to progressive deterioration of renal function [1]. Additionally, cyclosporine is associated with an increase in hypertension and dyslipidemia, which can further complicate the management of transplant patients [2].

Cyclosporine can also cause adverse metabolic effects, such as alterations in glucose and lipid metabolism. These effects may be more pronounced compared to other immunosuppressants like tacrolimus, although both present significant risks [3]. Furthermore, prolonged use of cyclosporine can lead to cosmetic complications and an increased risk of infections due to generalized immunosuppression [4].

Precautions in the Use of Cyclosporine

Managing cyclosporine requires an individualized approach, considering the appropriate dose and formulation to minimize adverse effects. It is crucial to regularly monitor renal function and blood pressure levels in patients receiving cyclosporine. Additionally, the possibility of pharmacological interactions should be taken into account, especially with medications that affect cyclosporine metabolism, such as ketoconazole [5].

In the context of post-transplant immunosuppression, it is essential to balance the risk of graft rejection with the risk of adverse effects. The choice of immunosuppressive therapy should be based on a careful assessment of risks and benefits, and it may be necessary to adjust therapy based on the patient's response and the occurrence of side effects.

Conclusions

Cyclosporine remains an essential component of immunosuppressive therapy for transplant patients, but its use requires constant vigilance due to its potential adverse effects, such as nephrotoxicity and hypertension. Personalizing treatment and regular monitoring are key to maximizing the benefits of cyclosporine while minimizing its risks. Ongoing research and the development of new therapeutic strategies are necessary to improve long-term outcomes in patients who rely on immunosuppression.

Referencias

• [1] Cyclosporine nephrotoxicity
• [2] The metabolic effects of cyclosporin and tacrolimus
• [3] Tacrolimus versus cyclosporine as primary immunosuppression after heart transplantation
• [4] Cyclosporin in dermatology: A practical compendium
• [5] Review of the pharmacokinetics, interactions and adverse reactions of cyclosporine in people, dogs and cats

Created 6/1/2025